At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind.

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Whether you recognize the term or not, at some point you have dealt with a cognitive distortion. These are thoughts that feel like the truth, but they describe an emotional reality rather than an objective one. For those struggling with stress, anxiety, or depression, often chronic and significant cognitive distortions play a big role in the struggle.

Dr. David Burns (1980) outlined 12 of the most common cognitive distortions in his book, Feeling Good: The New Mood Therapy. Dr. Burns’ list is adapted below with examples. As you read through the list, see if you recognize examples of any of these distortions in your life.

1. All-Or-Nothing (Black and White) Thinking: You see things in black and white terms, refusing to see any gray area.Distortion: If I’m not nice to everyone all the time, I’m a jerk.Reframe: I’m allowed to be assertive and set boundaries. I don’t have to be nice to someone who is being disrespectful to me. Standing up for myself doesn’t make me a jerk.

2. Overgeneralization: You see one or several negative events as a sign of an endless pattern of defeat.Distortion: I got a bad grade on this math test, so I will never get a good grade on a math test.Reframe: I got a bad grade on this math test. Maybe I didn’t understand the material or studied wrong. I will talk to my teacher to better understand my mistakes, and hopefully I will do better next time.

3. Mental Filter: You exclusively notice the negative aspects of a situation and magnify them out of proportion. At the same time, you filter out/fail to notice the positive aspects.Distortion: My presentation went terribly. I lost my train of thought because I got nervous, and I forgot a key point I wanted to make.Reframe: I stumbled over my words a little bit, but no one besides me seemed to notice. I also forgot a key point I wanted to make. But I got good feedback and everyone seemed engaged during my presentation. Next time I will practice a little bit more, but overall it went pretty well.

4. Minimizing/Disqualifying/Overlooking the Positive: You turn positive experiences or comments into negative ones by deciding that they don’t count for some reason. You overlook positive things about yourself or your environment. You don’t just filter out positive things; you actually turn them into negatives.Distortion: He only invited me to come to his party because he feels sorry for me and knows I’m a loner.Reframe: He invited me to come to his party because he wants me to come.

5. Mind Reading: You assume that someone is thinking or reacting negatively to you even though you do not know what they’re thinking.Distortion: She didn’t wave at me because she doesn’t like me.Reframe: She didn’t wave at me. She probably didn’t see me, or maybe she had something on her mind.

6. Fortune Telling: You think that something bad is going to happen even though you do not yet know what the outcome will be. This causes you to worry, overreact, or give up too soon.Distortion: Even though things are going well now, I think he will eventually break up with me and I am afraid I will get hurt. Maybe I should just break up with him now to avoid getting hurt.Reframe: Things are going well now. I’m not sure what will happen in the future. But for now I will try to be present and enjoy what is.

7. Magnifying/Catastrophizing: You exaggerate the importance of something, or you imagine that something that might happen would be terrible or earth shattering, when it would not actually be as bad as you imagine or you could cope despite it being difficult.Distortion: I can’t accept the promotion because then I will have to give presentations. I’m terrified of public speaking, and I will get too scared and embarrass myself in front of everyone and then probably lose the job anyway.Reframe: If I accept the promotion, I will have to give presentations. Lots of people are scared of public speaking. I might make a mistake and I might feel embarrassed or scared, but that’s part of being human. It won’t be the end of the world.

8. Emotional Reasoning: You assume that your feelings reflect the truth, even though your feelings are based on erroneous thinking.Distortion: I feel like a failure, which means I am a failure.Reframe: I may feel like a failure right now because I am still looking for a job, but job hunting takes time. I am not a failure.

9. Should Statements: You have a list of rules set in stone about how you or others “should” behave, but these rules are arbitrary or unrealistic. You feel guilty or inadequate when you “break” a rule, or get angry or frustrated when others do so.Distortion: I should have enough time and energy after work to play with the kids. I feel guilty if I let them watch TV while I finish up some work instead, and I feel frustrated with my spouse when he/she does the same. Reframe: I want to have enough time and energy after work to play with the kids. But sometimes I will be too busy or tired. I will do my best to spend quality time with them, even if sometimes that means cuddling on the couch watching TV while I finish up some emails. On those nights when I really can’t find the time, I will give myself (and my spouse) grace.

10. Labeling: When someone makes a mistake, you don’t objectively evaluate the mistake. Instead you label the person – “I’m a failure” or “They’re an idiot.”Distortion: He forgot to lift the toilet seat again! He is so inconsiderate. Or I forgot my kids had a half day today. I’m a terrible parent!Reframe: He forgot to lift the toilet seat again. He must have had something else on his mind. Or I forgot my kids had a half day today. Today was really busy and I had too much on my mind. Maybe I need to write down half days on my calendar from now on.

11. Personalization: You think that things that others do or things that happen to you are personalized reactions to you, even if this is not the case.Distortion: My friend didn’t return my text because she thinks I’m annoying.Reframe: My friend didn’t return my text. Maybe she is really busy or has something going on in her life I don’t know about. Sometimes I forget to return texts too.

12. Probability Overestimation: You overestimate the likelihood of something bad happening.Distortion: If I drive, I will get in a car accident, so I am not going to get my driver’s license.Reframe: Accidents can happen anytime, but the odds are not high. Most people drive every day and nothing bad happens.

Cognitive distortions are not constructive, but experiencing a distortion every now and again is simply part of being human. However, when you are not able to reframe your distortions, or when cognitive distortions begin driving your behavior, they can become a problem.

Cognitive Behavioral Therapy (CBT) works to help clients notice, address, and alter these destructive thoughts. When you believe your own destructive thoughts, you may also tend to avoid certain situations on the basis of a false belief. CBT also works to help clients slowly learn to approach rather than avoid such situations. Having a warm, empathic therapist come alongside you throughout this process is healing. She can model compassion for you, helping you learn to have compassion for yourself, while still challenging you to see things in a new and healthier way.

If you find yourself feeling overwhelmed by cognitive distortions, stress, anxiety, and/or depression, you do not have to struggle alone.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Do you often find yourself lying awake at night, staring at your alarm clock as it ticks away the time? Or, do you wake regularly during the night, leaving you feeling as if you haven’t slept at all?

According to the National Sleep Foundation, nearly half the population reports suffering from at least one symptom of insomnia (difficulty falling asleep, frequent nighttime awakenings, waking up too early, and waking up feeling unrested).

Many of your daily habits likely play a bigger role in your nightly struggles than you think. Both our ability to fall asleep, and the quality of sleep we have are highly dependent on a variety of external and internal stimuli.

Learning about how each activity impacts your sleep patterns can help you make changes and finally get a good night’s rest.

1. Exercise

Why An Exercise Routine Helps Regulate Sleep

Body heat: Part of the natural changes our circadian rhythm brings about over the day are changes in body temperature.

The rise and fall of our body temperature associated with exercise mimics the natural fluctuations which lead up to sleep.

This can be enough to gently nudge your circadian rhythms back into ideal synchronization if exercise is performed at the right time of day. 1

Beneficial stressor: Exercise is a “beneficial stressor” in that it activates sympathetic nervous system (our flight-or-fight response). Your body compensates by increasing the time spent in deep sleep - leaving you feeling more rested.

Decrease stress, anxiety and depression: Many of us experience difficulty falling asleep due to ruminating thoughts related to real or perceived stress.

Exercise has been scientifically proven to reduce reactivity to stressors, so that we are better able to manage stressful situations when they come our way.

It has likewise proven itself to be effective in reducing the symptoms of anxiety and depression. 2

What Kind Of Exercise Should I Do?

Aerobic exercises (“with oxygen”) include any that involve sustained activity which requires the body to consume large amounts of oxygen, such as walking, swimming and biking.

Whereas, weight training and sprinting are anaerobic exercises. While an important component of a healthy lifestyle, these activities are not effective for promoting sleep. 3

What Time Of Day Should I Exercise?

While fitting in exercise whenever feasible for your lifestyle can go a long way towards improving your sleep, studies have shown that exercising in the late afternoon or early evening has the greatest impact.

The reason for this relates back to how exercise promotes better sleep: In order to take advantage of the drop in body temperature you’ll want to complete your workout approximately 3-5 hours before bedtime.

How Long Should I Exercise?

While exercising for 15-45 minutes daily is the optimal duration; however studies have shown that 150 mins/week is sufficient to see improvements in quality of sleep up to 60%.

2. Diet

Your diet impacts your sleep through more means than just providing calories: What we eat and when we eat it can enhance or inhibit our sleep.

Foods That Inhibit Sleep

1. Coffee: Caffeine has a half-life of 5 hours: which means that 10 hours after drinking your coffee, 25% left in your system; and 20 hours later 12.5% of the caffeine still remains.10

So, while an early afternoon coffee as a post-lunch pick-me-up may seem like a good idea, it might be what is keeping you up at night.

2. Alcohol: Alcohol is a little more tricky in how it affects sleep; because it causes drowsiness many mistakenly believe that a drink can serve as a sleep-aid.

However, research has shown that while alcohol increases slow-wave sleep during the first half of the night, it actually leads to an increase in sleep disruptions during the second half. 4

3. Chocolate: Chocolate, particularly dark chocolate, can contain high levels of caffeine and thus needs to be treated similarly to coffee and other caffeinated beverages.

In general try to avoid any kind of sweets in the evening though since it will not only improve your sleep but your overall health as well.

4. Spicy Foods: Capsaicin - the molecule which gives your spicy foods that kick - can causes changes in body temperature that can cause a disturbance in your circadian rhythms if consumed late at night.

5. High-Fat Foods: We all know that certain unhealthy fats negatively impact our health; but there’s also evidence that they may be keeping you up at night.

Animal studies have shown that high-fat diets are associated with more fragmented sleep, along with excessive daytime sleepiness.

Researchers speculate that this may be linked to the neuro-chemical orexin -- which plays an integral role in our sleep-wake cycles. Rats who were fed high-fat diets showed a decrease in orexin-sensitivity. 5

Foods That Promote Sleep

There are many foods that are lauded for their ability to promote a better, more restful sleep. These are the key components you want to be on the lookout for when planning your bedtime snack:

1. Magnesium and potassium: One of the symptoms of magnesium deficiency is insomnia, so you’ll want to load up on healthy sources of this mineral such as leafy greens, beans and lentils, and bananas. 6

Magnesium and potassium promote muscle relaxation, and thus not only help you feel more comfortable but can help deal with nighttime leg cramps.

2. Tryptophan:Tryptophan is an amino-acid found in both animal and plant proteins. Our bodies use tryptophan to create serotonin -- a neurotransmitter involved in both mood regulation and sleep cycles.15

Many foods are great natural sources of tryptophan, such as milk, bananas, peanut butter and walnuts.

3. B Vitamins: B vitamins are essential for both the synthesis and release of certain neurotransmitters and hormones that are part of the sleep-wake cycle: such as serotonin and melatonin.

Supplements are often prescribed to treat restless-leg-syndrome - a nighttime movement disorder which significantly disrupts sleep.

However, there’s no need to take a supplement. You can get your fill from legumes (chick peas), dark green vegetables, whole grains and fish. 7

4. Theanine: Theanine is yet another useful amino acid when it comes to treating sleep disorders. Research has shown that administering a theanine supplement improves sleep quality and increases sleep efficiency, while decreasing nighttime awakenings.

There is one superfood packed with theanine: Green tea. However, while green tea has significantly less caffeine than a cup of joe, it is recommended to opt for the decaffeinated kind if your goal is a good night’s sleep. 8

5. Melatonin: Melatonin is naturally produced by your pineal gland under direction of your circadian rhythms and is what makes us feel sleepy as we near bedtime.

It usually begins to release around 9 p.m. and remains at a high level for the next 12 hours, throughout the night into the next morning.

While there are certain foods that contain melatonin, you can also purchase this essential sleep-inducing hormone in capsules at your local pharmacy or health food store.

Taken at the right time of day, and in the right dosage, melatonin supplements can help reset your biological clock to optimal levels and is often used as a natural treatment for sleep disorders.19

However, you don’t need to take supplements: simply add tart fruits, like cherries and pineapples, to your diet. Oats, walnuts and bananas are likewise great natural sources of melatonin.

Timing Your Meals

It’s not just what you eat, when you eat also counts.

Research at Yale’s School of Medicine has revealed just how vital the timing of our meals is to maintaining optimal circadian rhythms.

For instance, when we wake in the morning and our central clock is being stimulated by the light of day, but we decide to skip breakfast we have just given our body conflicting information that can in turn disrupt our circadian rhythms. 9

The main takeaway from this study and similar research is that you should not be eating close to your intended bedtime; but the recommendations for how long before bed you should refrain from eating vary: some saying not to eat after 7 pm, while others suggest 5 hours before lights-out and still others indicate a minimum of 12 hours before you eat breakfast.

It’s also recommended to reserve large meals for the first half of your day, and consuming lighter snacks in the evening.

3. Environment

Mattress & Pillows

When it comes to choosing a mattress and pillows, there’s no universal rule for everyone to follow. Whether you should opt for firm or soft, memory foam or pocket coil all depends on your personal preferences, particularly the position you sleep in.

Back SleepersSleeping on your back is often the sleep position recommended by doctors, since it allows the body to lay relatively straight.

However, that does not mean there is no pressure being put on your spine as you sleep.

You should have a mattress which is both able to support the spine -- and not allow the exaggeration of any curves -- but is also plush enough to not cause painful compression.

Opt for a medium to firm mattress

Memory foam is more ideal since conforms to natural curves while maintaining support

May substitute for a pocket coil with pillow top.

Side Sleepers: Sleeping on your side has its own benefits: It can help reduce acid reflux, reduces the pressure on the lungs, and promotes better blood circulation.

The main complaints of side-sleepers are achiness in the shoulder and hip area. The way to circumvent this is to ensure your mattress adequately cradles these parts.

Medium to soft mattress

Memory foam is ideal for reducing number of pressure points

Front Sleepers: Sleeping on your front is by far the worst for your health: Not only does it put pressure on your stomach, but the spine is the least supported in this position.

While it is recommended you switch sleeping positions, there are certain considerations when choosing a mattress that can help alleviate some of the negative side-effects.

Opt for a firmer mattressPocket-coil mattresses are a big no-no, as the entire front side of your body is exposed to the pressure points and they will not support your spine.

Bed Sharing

There’s no doubt that sharing beds can add to your difficulty getting a good night’s sleep.

It’s unlikely that both people with have identical wants and needs when it comes to their sleep position and mattress preferences; and when one partner is uncomfortable their tossing and turning can quickly cause problems for the other.

Upsize to a Queen: A Full-sized bed will leave you and your partner with only 27 inches of space -- which amounts to the size of a baby’s crib.

Opt for memory foam, or ditch your box spring: While memory foam is the optimal choice for reducing the transfer for movements, replacing your box spring with slats can serve as a quick fix.

Invest in a mattress designed for couples: The Sleep Number mattress let’s you and your partner select your ideal level of firmness, comfort and support so you don’t have to compromise.23

Colors

Research has shown that people who sleep in blue rooms tend to sleep longer than when compared to other colors. Blue toned walls can serve as yet another signal telling your brain it’s time to sleep.24

It’s important that your bedroom makes you feel comfortable and relaxed. It’s less important to follow a strict guide than to follow your own intuition.

Light

Light is one of the most powerful cues for your body’s internal clock, it’s thus important to ensure that you are exposing yourself to light and dark during the optimal times.

Try to keep your bedroom as dark as possible while you sleep by using black-out curtains.

However, lighting is not just important when you are sleeping. It’s recommended to dim the lights one hour before heading to bed to cue your brain it’s time for sleep.

For this reason it’s also best not to stare at bright screens (TVs, computers, and smartphones) during this time period, although many phones do offer a “night-mode” setting that can help.

In fact, the blue light -- in the 460-nanometer range -- emitted by electronics and energy-efficient lightbulbs has been shown to delay the release of melatonin.25

Temperature

This, yet again, links back to the natural changes that occur as part of your circadian rhythms: your body temperature drops during the night, and thus maintaining a cooler room will help maintain this.

Setting your thermostat far below or above this ideal point can make it more difficult to fall asleep, lead restlessness and even affect the time you spend in REM sleep.26

The material of your mattress, pillows, bed linens and pajamas can significantly impact your temperature while sleeping. Look for fabrics that are breathable and won’t trap heat such as cotton; likewise choose pillows made of natural materials over synthetic.

As for mattresses, memory foam is the best option when it comes to temperature control.

Noise

Your brain continues to register noises while you sleep, which although unknown to you may be causing you to toss-and-turn or wake briefly.

It’s more likely for a noise to wake you up while in stages 1 and 2 of sleep, than while in 3 and 4. Additionally noise tends to cause more sleep disruptions in the second half of the night.

There’s also evidence that you’re more likely to respond to a sound while sleeping if it is emotionally significant to you: Such as when a mother hears her baby crying.27

If noises outside of your control are keeping you up at night, white noise can be used to “drown” them out. White noise works by reducing the difference between the ambient noise and a sudden, “peak” sound -- like a toilet being flushed -- lowering the chances your sleep will be disturbed.

There are many white noise generators you can purchase, and now there are even phone apps that can do the trick. However, a simple fan or air purifier may be sufficient to help you sleep through the night.

4. Meditation

Fifty percent of people who experience difficulty sleeping blame stress and worry for their troubles.

Meditation, in relieving feelings of stress and anxiety, and - over time - improving our overall response to stressful situations, has been proven to improve both the duration and quality of sleep, with the effect increasing with prolonged practice.

Researchers at the Stanford Medical Center conducted a pilot study to investigate the effectiveness of meditation in treating insomnia. 10

Following a six-week mindfulness meditation training program, 60% of the participants no longer fit the qualifications for the diagnosis - falling asleep twice as quickly as they had previously.

A 12-month follow-up revealed that the majority of the benefits were long lasting.28 Similarly, experienced meditators show enhancement in both REM and non-REM sleep; as well as experiencing fewer awakenings when transitioning between cycles. 11

Meditating at any time of day helps to reduce stress and improve sleep; however, incorporating meditation into your bedtime routine can be especially effective in preparing your body and mind for sleep.

5. Structuring Your Bedtime Routine

Sleep is a behavior: You can teach yourself to sleep well, but you can equally teach yourself to sleep poorly. Our habits surrounding our bedroom routines have a much more significant impact on the quality of our sleep than many of us believe.

Children often have bedtime routines to encourage the onset of sleep, but this is just as important for adults.

Our body needs time to adjust and cool down after a busy day: Just as sleep inertia affects our ability to feel alert after being abruptly roused from a nap we need to allow our body and mind time to transition into a state of relaxation and finally sleep.

When structuring your bedtime routine the main goal is to reinforce your natural circadian rhythms. By developing a scheduled routine of activities at bedtime we can form habits that promote sleep, while avoiding those that impede it.

General Guidelines:

Follow a scheduled pre-sleep routine

Avoid stimulating activities and all screens for 30-60 minutes before bedtime

Reserve your bed for sleep and intimacy

Get rid of your alarm cloc

Rituals

Maintain a regular sleep/wake schedule (even on weekends): While it may seem like a treat to sleep in way past your usual waking time on the weekends, altering your sleep-wake schedule for just one night is sufficient to cause disruptions in your circadian rhythms that will affect you for days following.

Choose a favorite relaxing activity to wind down: Close off your day with a period of relaxation by incorporating one of your favorite calming activities into your bedtime routine.

Choose what works for you -- while one person may find reading relaxing, if you aren’t a bookworm yourself this will be counterproductive.

Some suggestions include:

Reading

Listening to music

Stretching (yoga)

Meditating

Prepare your room for sleep:

Dim the lights

Lower the temperature

Make your bed: A recent poll conducted by the National Sleep Foundation revealed that making your bed may be more than just a morning nuisance.

Those who reported they made their bed every morning had a 19% higher chance of getting a good night’s sleep than those who skipped this chore.

While the reason behind this is still unknown, researchers speculate that it’s related to feeling good about where you sleep.

Decluttering and maintaining a tidy bedroom can go a long way towards promoting better, more restful sleep.31

6. Tools And Resources

Nowadays there are many helpful tools to help you sleep better available at the click of a mouse -- or the swipe of a finger.

Sleep Cycle

Sleep Cycle Alarm Clock will revolutionize the way you wake up. This innovative app actually tracks your sleep patterns, and uses this information to gently rouse you when you’re in a light stage of sleep -- preventing sleep inertia.

The app achieves this by monitoring your movements throughout the night, as these vary depending on what stage of sleep you’re in.

There are two modes: Either using your phone’s microphone which “hears” your movements, or the accelerometer, which is placed on your mattress to detect your movements throughout the night.

At only $0.99 on iTunes it’s a small price to pay for waking up feeling refreshed.

F.lux

F.lux began as a software which adapts the colors of your computer’s display for different times of the day: Not only optimizing your viewing experience, but reducing your exposure to blue light - which inhibits the release of melatonin, a hormone essential for sleep.

While the app is still under construction, there are plenty of similar ones to choose from on iTunes and Google Play Store, so you can enjoy your devices in the evening without disrupting your sleep.

For iOS you can also use the built-in Nightshift mode to adjust white balance of your screen based on time of day.

White Noise

White Noise by TM Soft allows you to choose from a library of sound loops including beach waves, air conditioner and running water.

The app comes in three versions: Free, Full and Pro; with even the freebie coming with 40 sound loops as well as additional alarm sounds.

Whether you are looking for a way to drown out nighttime noise disturbances, or need a substitute for your favorite fan while traveling, White Noise’s variety will suit any preference.

Headspace

With short guided meditations readily available on both desktop and mobile devices Headspace makes it easy to incorporate meditation into your bedtime routine.

You can try their Take 10 program for free, or choose from a variety of subscription options to get started today.

GoodnighT

While lying awake at night staring at your alarm clock waiting for sleep to come may make you feel powerless, there are a lot of concrete actions you can take to conquer your sleeping problems once and for all.

It’s not necessary to undergo a total life overhaul in order to enhance the quality of your sleep. Start by experimenting with the tips that are most appealing to you and see how they impact your sleep.

Keeping a journal can help you track what works and what doesn’t. Once you’ve felt the effects of a good night’s sleep you’ll wonder how you ever got by without it.

As we enter another new year, many of us have set our 2017 resolutions. Maybe you make resolutions, maybe not, but either way this is generally a time of reflection. In what ways do we hope this year will be different from last? What are we hoping to change in our lives? What goals do we have going forward?

The new year always seems to be a good time to think about making some changes because it gives us the chance to start fresh in some ways. But in other ways it is simply just another day. Nothing changed automatically on January first. What can change is our perspective, and it is our job to ensure that our actions follow. This is the tough part. Do you find yourself already struggling to maintain your resolution? Do you wonder why we have such a hard time keeping our resolutions for more than a few weeks? How do we make our resolutions stick?

The truth is, change is often slow. Occasionally we are able to make huge changes immediately, but more often than not change takes time. New year's resolutions often fail to take into account that it may actually take you all year to create the change you were hoping to see on January second. When we fail to recognize all the small steps on the road toward change, we set ourselves up for disappointment and failure. A new year's resolution sounds like an easy solution: set a major goal for the new year ahead. But our resolutions are empty unless they are backed by action, and creating a resolution doesn't necessarily help us to make an action plan.

Acceptance and Commitment Therapy (ACT) offers some ideas and tools that can be very helpful in guiding us along the process of change. Whether you come in to see a therapist for Acceptance and Commitment Therapy, or whether you apply the wisdom it can offer to your life on your own, this model can help us to keep our resolutions all year long.

ACT aims to increase psychological flexibility, which means that you are able to connect to the present moment consciously and choose to behave in a manner as consistent with your values as the situation allows. Part of the purpose behind ACT is to get in touch with your personal values (not those determined for you by society, family, friends, or any other external source), and then use these values to guide your actions and formulate specific goals. This is usually what we are aiming for with our new year's resolutions.

For example, if my resolution is that I want to eat healthier, a good place to start is to examine my values. Do I feel like I "should" eat healthier because I feel pressured by our health conscious culture or by my friends, family or partner? Or do I want to eat healthier because I value my physical health, deep in my heart? Or perhaps I value my role as a model to my children, and want to eat healthier for this reason. Once I determine my values and make sure that my resolution is driven by my own intrinsic motivation, then I can create a concrete plan of action to move forward.

The Choice Point Model, another helpful ACT tool, offers us a framework to use when we face a decision. A choice point is a moment in time where we can choose to act in a manner that is either consistent or inconsistent with our values. The Choice Point is about identifying the hundreds of moments in a day where we can be on autopilot and be driven by thoughts and feelings, or we can make a conscious, deliberate choice that is in the service of our values. When in this moment, we can use the acronym STOP:

S: Slow down. Take 3 mindful breaths.

T: Take notice. What are you thinking and feeling?

O: Open up. Make room for those thoughts and feelings instead of trying to avoid the discomfort.

P: Pursue values. Do what matters to you.

Sometimes, in a Choice Point, we will choose to avoid or procrastinate acting in a values consistent manner, and that is okay. Give yourself grace when this happens. But remember that though avoidance may provide relief for the moment, in the long run it will make us feel worse. So if we can STOP and choose to act in accordance with our values as frequently as possible, it will serve us.

As you approach this new year and begin thinking about your potential resolutions, remember that big change happens slowly, choice point by choice point. Remember to consider your values, and to STOP when you hit a choice point. If you feel you need some extra support along the road to change or healing...

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance

grounding, mindfulness, and relaxation

reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance

video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Anxiety is a hot topic these days. It’s all over the news, and apparently it is on the rise. In the age of information and technology, we are constantly bombarded with doom and gloom news alerts, including reminders that on top of everything else, we are plagued with increasing anxiety. Eventually, these reminders can get exhausting and may even contribute to the anxiety that is apparently so prevalent in the first place.

Image source: https://www.theodysseyonline.com/poems-read-anxiety

Of course, there are benefits to all this conversation around anxiety: we have a better understanding of what anxiety is and as a result we may be able to understand and empathize with those who are struggling better. But it’s important to be careful that we don’t pathologize all anxiety, and that we don’t lose sight of the strength that exists in those who truly do have anxiety disorders.

Anxiety: Natural Response to Stress or Disorder?

The way we talk about anxiety today, it is easy to believe that all anxiety is inherently bad and forget that it’s our natural response to threat or danger. We actually need anxiety to survive; it prepares our body to respond appropriately in the face of danger. However, our physiological experience of anxiety developed back when the regular dangers humans faced included running from large, sharp toothed predators. So when we are experiencing the fight-or-flight response before a big exam or presentation, it may not feel particularly adaptive. But despite the discomfort that comes with anxiety, it is natural when it is experienced as the result of a particular situation or problem, when it is proportional to the stressor, and when it only lasts until the situation is resolved (ULifeline, 2016). Anxiety, though often painful, is an important and adaptive part of the human experience.

Image source: aconsciouslifenow.com

Though originally an adaptive response, anxiety does have the potential to be harmful when it manifests as “constant, chronic and unsubstantiated worry that causes significant distress, disturbs your social life and interferes with classes and work” (Active Minds, 2016). In other words, anxiety is no longer helpful when it begins to appear when there is no actual threat present. When a person experiences anxiety but has no threat to respond to, what happens? They begin avoiding situations that are actually safe. Their mind and body are telling them that safe situations are threatening, which can have a debilitating effect. When anxiety becomes disordered, it arises unexpectedly, is overwhelming, and, rather than catalyzing adaptive behavior in the face of a threat, often fosters avoidance of everyday situations (Here to Help, 2016).

So what is the takeaway? Anxiety is uncomfortable, but it helps us respond to threat, uncertainty, trouble, or feelings of unpreparedness (Active Minds, 2016). Anxiety becomes a problem (and possibly a disorder) when it comes seemingly out of nowhere and in the absence of a stressor proportional to the response, and it interferes with functioning in some way.

Recognizing Strengths as well as Struggles

There is no denying that feeling anxious is not pleasant. It can range from uncomfortable to unbearable. For those with anxiety disorders, anxiety is unpleasant on a whole new level; it can be completely overwhelming and paralyzing. It is hard to describe how out of control one can feel in the middle of a panic attack, or how draining it is to go through the day (week, month, or year) flooded with anxiety.

But in the midst of this struggle, it’s important to remember that anxiety doesn’t own you. It may be a part of you, and it may influence your life in various and profound ways. But anxiety does not determine who you are. A diagnosis does not define you. You are not a disorder. You are not weak, powerless, or alone.

Image source: http://quotesgram.com/from-brene-brown-quotes/

Acknowledging the pain anxiety can bring is so important, but it can also be helpful to recognize that struggling with anxiety may also foster certain strengths. According to Dr. Tracy Foose (2013), trait anxiety is associated with being “highly conscientious, honest, detail oriented, performance driven, socially responsible, [and] self-controlled.” Furthermore, learning to cope with anxiety can push us towards an increased self-awareness and knowledge of ourselves. Because it is so uncomfortable, it can motivate us to grow and change parts of ourselves or our lives that may not be serving us. And once we learn that we can move through the discomfort of anxiety, we often feel stronger and more confident in ourselves knowing that we have the fortitude to move through something so profoundly difficult (Sutherland, 2011).

Finally, if you do feel like anxiety is controlling your life, you don’t have to stay stuck in this space. Not only can anxiety teach you to embrace vulnerability and reach out for support from loved ones, but therapy offers very effective treatment. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can teach valuable coping skills, and can help to change your relationship to anxiety. Nothing will ever take anxiety away completely, but we wouldn’t want that because without anxiety, we wouldn’t survive. But therapy can help us learn that even in the worst throws of anxiety, we will survive, and even thrive.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.